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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700220
Report Date: 01/29/2025
Date Signed: 01/29/2025 11:14:33 AM

Document Has Been Signed on 01/29/2025 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHHON, NARYFACILITY NUMBER:
015700220
ADMINISTRATOR/
DIRECTOR:		CHHON, NARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 815-9346
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/29/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Nary Chhon TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Nary Chhon for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Present during this inspection were the Licensee and helper supervising two (2) infants and six (6) preschoolers. The Licensee is within the capacity limits of a Large License. The two-story home has four bedrooms, three bathrooms, a large open entryway, a den, a living room, a kitchen, a dining room, a laundry room, a garage, and a backyard. The hours of operation are 8:30 AM- 5:30 PM, Monday -Friday. The Licensee has liability insurance through state farm Insurance.
On-limit-areas: are the large open entryway, dining room, kitchen, living room, den(playroom), and backyard. Off-limit areas: the entire second floor and garage.

The Daycare Area is clean, orderly, and equipped with age-appropriate toys for children. The home has a working telephone and a fire extinguisher, meeting the minimum requirements. During today's inspection, LPA did not observe any bodies of water. During the inspection, the Licensee confirmed that no firearms are stored in the house. A fireplace in the living room is screened to prevent access to the children in care. The Licensee also confirmed that the fireplace is not used during operational hours. There are child-size tables and chairs for snacks and activities. The napping room had cots in good condition and each child have their separate blankets. The parents wash the blankets weekly. A child safety gate is located at the bottom of the stairs to prevent access to the stairs and upper levels for children in care. The outdoor play area is fenced.
The Licensee's CPR expires on 5/25, and the Licensee has current Mandated reporter training on the file. As per the fire/disaster drill log, the last emergency drill was on 12/13/2024. The Licensee provides daily snacks and meals. LPA reviewed children's files. All the files are complete. All required postings are properly posted. The Licensee stated that she takes the children for a walk around the block. LPA reminded the Licensee that 100% visual and physical supervision is required when going around the block with the children. The facility roster was reviewed, and a copy was obtained. The Licensee documents 15-minutes sleep checks for the infants enrolled.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CHHON, NARY
FACILITY NUMBER: 015700220
VISIT DATE: 01/29/2025
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During Inspection, Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

No deficiency is cited today.


Exit interview conducted and report was reviewed with the licensee, Nary Chhon.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
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